Behavioral Wellness. Garden Fountain by Bridget Hochman BUDGET & FULL-TIME EQUIVALENTS SUMMARY & BUDGET PROGRAMS CHART

Garden Fountain by Bridget Hochman BUDGET & FULL-TIME EQUIVALENTS SUMMARY & BUDGET PROGRAMS CHART Operating $ 109,040,762 Capital $ 46,000 FTEs 432.10 Alice Gleghorn, PhD Director Administration & Support Mental Health Inpatient Services Mental Health Outpatient Services Mental Health Community Services s Alcohol & Drug s Health & Human Services D-191

Department MISSION STATEMENT Promote the prevention of and recovery from addiction and mental illness among individuals, families, and communities, by providing effective leadership and delivering state-of-the-art, integrated, accessible, and culturally competent services. DEPARTMENT DESCRIPTION The Department of Behavioral Wellness promotes the prevention of, and recovery from, addiction and mental illness among individuals, families and communities, by providing effective leadership and delivery of state-of-the-art, culturally competent services. In FY 14-15, 7,600 individuals of all ages received specialty mental health services throughout three key age groups: Children, Transition Age Youth and Adults, and 4,500 people served were in our Alcohol and other Drug programs. A variety of tailored services are offered including inpatient, outpatient and crisis. In June 2013, at the direction of the Board of Supervisors, a comprehensive Systems Change initiative began based on two commissioned reports from TriWest Group and Health Management Associates (HMA). Systems Change remains active within Behavioral Wellness and uses a continuous quality improvement (CQI) approach to address problems documented by the comprehensive reports. The unprecedented Countywide Systems Change effort has focused on access to services, welcoming clients, increasing cultural competence, the integration of peer staff, improved services for children and individuals in crisis, and enhanced forensic services. The most recent change resulting from Systems Change efforts is the name and identity change of the department, that occurred in February, 2016. HIGHLIGHTS OF 2016-18 OBJECTIVES Alcohol and Other Drug Development of Screening, Brief Intervention and Referral to Treatment (SBIRT) services in Isla Vista. Continued integration of alcohol and other drug (AOD) with mental health and primary care services by Drug Medi-Cal (DMC) Certifying existing mental health clinics. Establishment of Intensive Outpatient Treatment (IOT) services in every region of the county and sobering center in Isla Vista Administration and Support Creation of a comprehensive, integrated, behavioral health system The Office of Strategy Management supports creating, communicating, executing and sustaining strategic initiatives; improvement in communications, outcome measurement, and staff development. Established departmental metrics developed and approved by the BOS for semi-annual distribution. Departmental identity and name change. Mental Health Community Services Implement crisis stabilization units in North. Crisis stabilization unit and Crisis Residential House in South County now open Continue to improve access to health care through Mental Health Services Act funding and Affordable Care Act that allowed us to serve all based on clinical need. Mental Health Inpatient Services Complete planning of a Consolidated Mental Health Treatment Center to provide for additional inpatient beds in Santa Maria in conjunction with Marian Medical Center. Improve client outcomes and reduce lengths of stay through the expansion of the crisis service system (SB 82) Mental Health Outpatient Services Establish evidence-based practices delivered through specialty teams at all adult and children s outpatient clinics to individualize services based on unique needs. Expand Forensic programming and Homeless services countywide. Health & Human Services D-192

Adopted Full-Time Equivalents (FTEs) Behavioral Wellness Department RECOMMENDED SOURCES & USES OF FUNDS Source of Funds - $116,010,259 Use of Funds - $116,010,259 Charges for Services 45% $52,307,844 Mental Health Community Services 60% $69,789,160 Intergovernmental Revenue 44% $50,540,576 Alcohol & Drug s 11% $12,894,391 General Fund Contribution Intrafund Expenditure Transfers(-) $4,166,900 4% $4,507,181 4% Administration & Support Mental Health Inpatient Services 9% 9% $10,436,715 $10,159,555 Other Financing Sources $2,119,125 2% Mental Health Outpatient Services $5,760,941 5% Decreases to Fund Balance $1,780,292 2% Other Financing Uses 2% $2,313,902 Miscellaneous Revenue $352,414 0% Intrafund Expenditure Transfers(+) 4% $4,507,181 Use of Money and Property Fines, Forfeitures, and Penalities $232,427 0% $3,500 0% Increases to Fund Balances Capital Assets 0% 0% $102,414 $46,000 STAFFING TREND The staffing trend values will differ from prior year budget books in order to show amounts without the impact of any vacancy factors. 460 440 420 400 380 360 340 320 300 280 260 357.9 311.0 316.2 282.5 283.2 297.2 291.6 410.2 433.3 432.1 432.1 Health & Human Services D-193

Department BUDGET OVERVIEW Change from 2014-15 2015-16 FY15-16 Ado 2016-17 2017-18 Staffing Detail By Budget Actual Adopted to FY16-17 Rec Recommended Proposed Adminstration & Support 64.78 67.85 (1.00) 66.85 66.85 Mental Health Inpatient Services 38.92 46.60 (1.11) 45.50 45.50 Mental Health Outpatient Services 22.41 30.57 (1.80) 28.77 28.77 Mental Health Community Services 188.21 275.99 2.74 278.73 278.73 Alcohol & Drug Progams 9.74 12.25-12.25 12.25 Unallocated 4.16 - - - - Total 328.20 433.26 (1.16) 432.10 432.10 Budget By Budget Adminstration & Support $ 15,682,988 $ 10,442,836 $ (6,121) $ 10,436,715 $ 10,864,009 Mental Health Inpatient Services 10,104,545 9,822,923 336,632 10,159,555 10,025,068 Mental Health Outpatient Services 3,966,399 6,003,663 (242,722) 5,760,941 5,986,657 Mental Health Community Services 60,409,685 66,363,788 3,425,372 69,789,160 72,065,146 Alcohol & Drug Progams 11,786,464 12,248,195 646,196 12,894,391 15,386,563 Unallocated (361) - - - - Total $ 101,949,720 $ 104,881,405 $ 4,159,357 $ 109,040,762 $ 114,327,443 Budget By Categories of Expenditures Salaries and Employee Benefits $ 38,084,824 $ 47,497,112 $ 4,601,245 $ 52,098,357 $ 54,371,191 Services and Supplies 54,733,299 54,774,475 (204,873) 54,569,602 57,538,416 Other Charges 9,131,597 2,609,818 (237,015) 2,372,803 2,417,836 Total Operating Expenditures 101,949,720 104,881,405 4,159,357 109,040,762 114,327,443 Capital Assets (366) 1,154,994 (1,108,994) 46,000 46,000 Other Financing Uses 979,421 2,216,704 97,198 2,313,902 2,173,042 Intrafund Expenditure Transfers (+) 4,357,107 329,853 4,177,328 4,507,181 4,513,207 Increases to Fund Balances 1,923,365 88,648 13,766 102,414 103,950 Total $ 109,209,248 $ 108,671,604 $ 7,338,655 $ 116,010,259 $ 121,163,642 Budget By Categories of Revenues Fines, Forfeitures, and Penalties $ 3,439 $ 2,679 $ 821 $ 3,500 $ 3,500 Use of Money and Property 163,939 230,945 1,482 232,427 228,164 Intergovernmental Revenue 48,231,721 47,702,935 2,837,641 50,540,576 49,025,150 Charges for Services 42,400,587 48,618,748 3,689,096 52,307,844 55,564,304 Miscellaneous Revenue 465,814 342,549 9,865 352,414 353,950 Total Operating Revenues 91,265,499 96,897,856 6,538,905 103,436,761 105,175,068 Other Financing Sources 9,393,504 4,264,681 (2,145,556) 2,119,125 1,678,681 Intrafund Expenditure Transfers (-) 4,357,107 329,853 4,177,328 4,507,181 4,513,207 Decreases to Fund Balances 1,127,039 3,053,514 (1,273,222) 1,780,292 1,594,325 General Fund Contribution 3,066,100 4,125,700 41,200 4,166,900 4,233,100 Fund Balance Impact (-) - - - - 3,969,261 Total $ 109,209,248 $ 108,671,604 $ 7,338,655 $ 116,010,259 $ 121,163,642 Health & Human Services D-194

Department CHANGES & OPERATIONAL IMPACT: 2015-16 ADOPTED TO 2016-17 RECOMMENDED Staffing Decrease of 1.16 extra help FTEs that primarily supported a one time project to create electronic health records by archiving and scanning all paper medical charts. Expenditures Net operating expenditure increase of $4,200,000: o $4,600,000 increase in Salaries and Employee Benefits due to implementation of the Crisis Stabilization unit and overall salary and benefit rate increases. o -$200,000 decrease in Services and Supplies primarily due to lower community based organization costs. o -$200,000 decrease in Other Charges due to reduction in human resource services provided by another department. Net non-operating expenditures increase of $3,200,000 primarily due to: o $4,200,000 increase in the Intrafund Expenditure Transfers that allocates clinical supervision to programs. o -$1,100,000 decrease in capital assets from utilizing funding in FY 15-16 from rehabbing county facilities for Crisis Stabilization South and purchase of Crisis Stabilization North. These changes result in Recommended operating expenditures of $109,040,762, non-operating expenditures of $6,969,497, and total expenditures of $116,010,259. Non-operating expenditures primarily include capital assets, transfers, and increases to fund balances. Revenues Net operating revenue increase of $6,500,000: o +$3,700,000 increase in Charges for Services primarily due to: +$2,600,000 increase in Medi-Cal related revenue, +$300,000 increase in Administrative revenue between ADMHS funds, and +$140,000 increase in third party insurance revenue. o +$2,800,000 increase in Intergovernmental Revenue primarily due to: +$2,500,000 increase in Mental Health Service Act revenue, +$900,000 increase in 2011 Realignment revenues, and -$500,000 decrease in State grant funds due to use of one time grant award for capital. Net non-operating revenue increase of $800,000 primarily due to: o -$2,100,000 decrease in Other Financial Sources primarily due to one time Tobacco Settlement (TSAC) and General funding for the Inpatient System of Care and Laura s Law implementation plan, o -$1,300,000 decrease in the Department s use of fund balances, and o $4,200,000 increase in Intrafund Expenditure Transfers that allocates clinical supervision to programs. These changes result in Recommended operating revenues of $103,436,761, non-operating revenues of $13,373,248, and total revenues of $116,010,259. Non-operating revenues primarily include General Fund Contribution, transfers, and decreases to fund balances. Health & Human Services D-195

Department CHANGES & OPERATIONAL IMPACT: 2016-17 RECOMMENDED TO 2017-18 PROPOSED. Expenditures Net expenditure increase of $5,200,000 primarily due to: o +$2,300,000 increase in Salaries and Employee Benefits reflects increases in County retirement and health insurance contributions along with negotiated labor agreements. o +$3,000,000 increase in Services and Supplies primarily due to increase of community based organization and out of county contracted inpatient services costs. o +$45,000 increase in Other Charges due to higher costs for services provided by other departments. o +$140,000 decrease in Other Financing Uses between ADMHS funds. Revenues Total operating revenues are increasing $1,700,000 and non-operating revenue is increasing by $3,400,000 for a combined net total revenue increase of $5,100,000 primarily due to: o -$1,500,000 decrease in Intergovernmental Revenue reflects a decrease primarily from Senate Bill 82 Grant revenue targeted to end which will require review of ongoing sustainable structure and possible alternative funding mechanisms. o +$3,300,000 increase in Charges for Service from higher Mental Health and Drug Medi-Cal revenue. o -$180,000 decrease in Restricted Fund Balance due to a decrease in the Department s use of fund balances in FY 2017-18. o +$4,000,000 increase in Fund Balance Impact (-) due to a projected deficit in FY 2017-18 resulting primarily from: o +$2,500,000 decrease of Senate Bill 82 Grant revenue targeted to end, and o +$900,000 increase of out of county inpatient services costs. RELATED LINKS For more information on the Behavioral Wellness, refer to the website at http://countyofsb.org/behavioral-wellness/ Health & Human Services D-196

Department PERFORMANCE MEASURES Description Administration & Support Percent of departmental Employee Performance Reviews (EPRs) completed by the due date. The percentage of high cost Medi-Cal beneficiaries (greater than $30k per beneficiary, per year). (Goal: reduce by 7.5% per year) Mental Health Inpatient Services The percentage of clients who are readmitted to the PHF within 30 days of discharge. (Goal: decrease by 20% per year) The average acute inpatient length of stay. (VDM, Hillmont, PHF) (Goal: decrease to 7 days) FY 2013-14 Actual Not Used in Prior Years 4.76% 273/5,740 10% 42/421 Mental Health Outpatient Services: Percentage of children referred for mental health screenings and receiving mental health services, will receive specialty mental health services (Katie A class and subclass criteria). (Goal: 50%) The time between admission and the first psychiatrist appointment for adults (Goal: reduce by 20% per year) FY 2014-15 Actual 25.60% 53/207 4.18% 282/6,745 12.8% 37/290 FY 2015-16 Estimated Actual 37.80% 96/254 4.00% 240/6,000 12.40% 46/372 FY 2016-17 Recommend FY 2017-18 Proposed 80% 80% 3.7% 220/6,000 10% 37/372 3.7% 220/6,000 8% 37/372 10 days 10 days 11 days 7 days 7 days 58%* 364/628 *1/14-6/30/14 61% 280/459 48%* 118/245 *7/1/15-4/19/16 50% 50% 30 days 37 days 30 days 24 days 24 days The time between admission and the first psychiatrist appointment for children (Goal: reduce by 20% per year) 32 days 45 days 41 days 33 days 33days Health & Human Services D-197

Department PERFORMANCE MEASURES (CONT D) Description FY 2013-14 Actual FY 2014-15 Actual FY 2015-16 Estimated Actual FY 2016-17 Recommend FY 2017-18 Proposed Mental Health Community Service s: Percentage of adult clients served by the Crisis Stabilization Unit that stabilize in the community without need for involuntary inpatient care. (Goal: 85%) N/A N/A 85% 85% 85% Alcohol and Drug s Percentage of adults in substance abuse treatment will stay 90 days or more. (Goal: 60%) Percentage of adults receiving services in substance abuse programs will successfully complete treatment. (Goal: 50%) Percentage of youth in substance abuse treatment will stay 90 days or more. (Goal: 75%) Percentage of youth receiving services in substance abuse programs will successfully complete treatment. (Goal: 70%) 58% 1,548/2 40% 1,078/2,689 77% 529/687 57% 392/687 57% 1,633/2,847 44% 1,262/2,847 76% 529/696 61% 423/696 53% 1,684/3,194 60% 60% 40% 1,276/3,194 75% 525/700 60% 420/700 50% 50% 75% 75% 70% 70% Health & Human Services D-198

Health & Human Services D-199

ADMINISTRATION & SUPPORT The Administration & Support services include administrative leadership, patient rights, and business operations comprised of human resources, fiscal, management information systems, and facility oversight. Staffing Change from 2014-15 2015-16 FY15-16 Ado 2016-17 2017-18 Staffing Detail By Budget Actual Adopted to FY16-17 Rec Recommended Proposed DIRECTOR 0.54 1.00-1.00 1.00 DEPUTY DIRECTOR 1.00 1.00 1.00 2.00 2.00 ASST DIRECTOR 0.71 1.35-1.35 1.35 CHIEF FINANCIAL OFFICER 1.00 1.00-1.00 1.00 PROGRAM MANAGER 1.02 1.00 1.00 2.00 2.00 FISCAL MANAGER 0.65 1.00-1.00 1.00 HR MANAGER - - 1.00 1.00 1.00 PROGRAM/BUS LDR-GEN 0.69 - - - - IT MANAGER 1.63 2.00 (1.00) 1.00 1.00 EDP OFFICE AUTO SPEC 0.19 1.50 (0.50) 1.00 1.00 EDP SYS & PROG ANLST SR 2.27 3.00 (0.50) 2.50 2.50 FACILITIES MANAGER 1.00 1.00-1.00 1.00 FINANCIAL SYS ANALYST 1.00 1.00-1.00 1.00 EDP SYS & PROG ANLST 1.65 3.00-3.00 3.00 COMPUTER SYSTEMS SPEC SUPV 1.00 1.00-1.00 1.00 COST ANALYST 3.01 4.00-4.00 4.00 ACCOUNTANT SUPERVISING 1.00 1.00-1.00 1.00 ADMN OFFICE PRO 14.51 14.50-14.50 14.50 FINANCIAL OFFICE PRO 2.27 2.00-2.00 2.00 ACCOUNTANT 2.99 3.00-3.00 3.00 COMPUTER SYSTEMS SPEC 5.27 6.00-6.00 6.00 DEPT BUS SPEC 2.94 3.00-3.00 3.00 MEDICAL RECORDS ADMIN 1.00 1.00-1.00 1.00 PATIENTS RIGHTS ADVOCATE 0.77 1.00-1.00 1.00 FINANCIAL OFFICE PRO SR 1.69 2.00-2.00 2.00 ADMN OFFICE PRO SR 3.61 5.00 (1.00) 4.00 4.00 SAFETY OFFICER-DEPT 0.02 - - - - BUILDING MAINT WORKER 0.98 1.50-1.50 1.50 ADMHS RECOVERY ASSISTANT 0.34 - - - - EXTRA HELP 10.02 5.00 (1.00) 4.00 4.00 Total 64.78 67.85 (1.00) 66.85 66.85 Health & Human Services D-200

ADMINISTRATION & SUPPORT (CONT D) Revenue & Expenditures Change from 2014-15 2015-16 FY15-16 Ado 2016-17 2017-18 Budget By Categories of Expenditures Actual Adopted to FY16-17 Rec Recommended Proposed Salaries and Employee Benefits $ 7,056,638 $ 7,950,502 $ 500,719 $ 8,451,221 $ 8,832,483 Services and Supplies 1,921,231 1,871,293 (356,448) 1,514,845 1,554,410 Other Charges 6,705,119 621,041 (150,392) 470,649 477,116 Total Operating Expenditures 15,682,988 10,442,836 (6,121) 10,436,715 10,864,009 Capital Assets - 16,000-16,000 16,000 Other Financing Uses 263,621 310,543 (5,039) 305,504 302,854 Increases to Fund Balances 3,040 - - - - Total Expenditures $ 15,949,649 $ 10,769,379 $ (11,160) $ 10,758,219 $ 11,182,863 Budget By Categories of Revenues Use of Money and Property 4,239 (7,000) 10,913 3,913 - Intergovernmental Revenue 6,714,485 5,425,384 (2,927,848) 2,497,536 2,497,536 Charges for Services 9,003,849 9,077,994 304,720 9,382,714 9,644,992 Miscellaneous Revenue 179,450 - - - - Total Operating Revenues 15,902,023 14,496,378 (2,612,215) 11,884,163 12,142,528 Other Financing Sources 4,867,944 1,000,000 (1,000,000) - - Decreases to Fund Balances 3 - - - - General Fund Contribution 3,018,100 3,057,700 41,200 3,098,900 3,165,100 Total Revenues $ 23,788,070 $ 18,554,078 $ (3,571,015) $ 14,983,063 $ 15,307,628 2015-16 Anticipated Accomplishments Developed Organizational Leadership structure and filled vacant leadership positions allowing for greater organizational and management support of the service system and direct staff. Reduced overall vacancy rate to 16% allowing for overall increase in staffing capacity impacting increase in services. Initiated ProtoCall contract for after-hours behavioral health access call response & access data collection. Established new departmental identity and name change approved by the Board of Supervisors. Implemented data dashboard and client reports used to gauge client milestones, document deadlines & monitor staff workload. Health & Human Services D-201

ADMINISTRATION & SUPPORT (CONT D) 2016-18 Objectives Enhance service to clients with complex needs, continue the multi-year process to create a comprehensive and integrated behavioral health system that includes mental health services, substance abuse services, physical health care services, and support services. Create, execute and sustain strategic initiatives within the Department through continual measures of outcomes of care, program evaluation, and enhance training opportunities. Increase collaborative efforts to transform organizational culture with ongoing outreach and involvement in program development to staff, clients, families, and community-based providers, resulting in improved client outcomes. Augment capacity to measure and evaluate systems, programs, and individual outcomes. Provide structure and establish a framework for care and recovery by development of defined long-term organizational strategic plans. Improve management of care for high need, high utilization, high cost, and legal system involved clients. Present annual system report inclusive of annual metrics. Health & Human Services D-202

MENTAL HEALTH INPATIENT SERVICES Mental Health Inpatient Services include the Psychiatric Health Facility (PHF), out of County short and long term acute contracted beds, and inpatient residential mental health programs. Staffing Change from 2014-15 2015-16 FY15-16 Ado 2016-17 2017-18 Staffing Detail By Budget Actual Adopted to FY16-17 Rec Recommended Proposed PSYCHIATRIST 1.93 2.00-2.00 2.00 MEDICAL DIRECTOR 0.91 1.00-1.00 1.00 STAFF PHYSICIAN 0.50 0.50-0.50 0.50 PROGRAM MANAGER 0.08 - - - - PSYCHIATRIC NURSE SUPV 1.65 2.00-2.00 2.00 PSYCHIATRIC NURSE SR 0.01 - - - - ADMHS TEAM SUPV-RN 2.15 4.00-4.00 4.00 ADMN OFFICE PRO 1.54 1.50-1.50 1.50 PSYCHIATRIC NURSE 5.44 6.00-6.00 6.00 DEPT BUS SPEC - - 0.50 0.50 0.50 HEALTH CARE PROGRAM COORDINATOR 0.92 2.00-2.00 2.00 ADMHS PRACTITIONER 1.81 2.00-2.00 2.00 NUTRITIONIST 0.58 1.00-1.00 1.00 ADMHS TEAM SUPV-PSYCH TECH 0.88 1.00-1.00 1.00 ADMHS PSYCHIATRIC TECH 6.66 5.50-5.50 5.50 RECREATIONAL THERAPIST 1.17 1.25-1.25 1.25 ADMHS RECOVERY ASSISTANT 6.05 8.00-8.00 8.00 EXTRA HELP 6.61 8.65 (1.75) 6.90 6.90 CONTRACTOR 0.02 0.20 0.14 0.34 0.34 Total 38.92 46.60 (1.11) 45.50 45.50 Revenue & Expenditures Change from 2014-15 2015-16 FY15-16 Ado 2016-17 2017-18 Budget By Categories of Expenditures Actual Adopted to FY16-17 Rec Recommended Proposed Salaries and Employee Benefits $ 5,450,480 $ 5,936,179 $ 298,478 $ 6,234,657 $ 6,479,660 Services and Supplies 4,378,454 3,680,956 (1,716) 3,679,240 3,295,396 Other Charges 275,611 205,788 39,870 245,658 250,012 Total Operating Expenditures 10,104,545 9,822,923 336,632 10,159,555 10,025,068 Total Expenditures $ 10,104,545 $ 9,822,923 $ 336,632 $ 10,159,555 $ 10,025,068 Budget By Categories of Revenues Intergovernmental Revenue 73,175 1,328,136 1,241,714 2,569,850 2,577,328 Charges for Services 3,740,404 4,763,838 718,328 5,482,166 5,490,866 Miscellaneous Revenue 1,326 - - - - Total Operating Revenues 3,814,905 6,091,974 1,960,042 8,052,016 8,068,194 Other Financing Sources 2,154,208 500,000 (59,556) 440,444 - Total Revenues $ 5,969,113 $ 6,591,974 $ 1,900,486 $ 8,492,460 $ 8,068,194 Health & Human Services D-203

MENTAL HEALTH INPATIENT SERVICES (CONT D) 2015-16 Anticipated Accomplishments Improved utilization management system at the Psychiatric Health Facility (PHF), improvements made in access to inpatient care as well as reductions in lengths of stay by utilization of expediency in step down options in care. Integrated and increased use of Electronic Health record to ensure continuity of care between inpatient and outpatient setting. Focused inpatient treatment on recovery and re-entry into the community by incorporating peer recovery specialists into program operations. Expanded the capacity to treat complex conditions by integration of alcohol and drug assessments and services in the inpatient setting. Opening of South County Crisis Stabilization Unit. 2016-18 Objectives Improve client outcomes and reduce lengths of stay through the expansion of the crisis service system through new crisis system resources, funded through SB 82. Increase access to inpatient care by improved utilization management of the PHF reducing lengths of stay and stepping down level of care as quickly as possible. Complete planning of a Consolidated Mental Health Treatment Center to provide for additional inpatient beds in Santa Maria. Increase access to services by the creation of additional housing options within the community to allow for restoration of competency on an outpatient basis, when clinically appropriate, rather than extending inpatient lengths of stay. Open Crisis Stabilization Unit in North County. Health & Human Services D-204

MENTAL HEALTH OUTPATIENT SERVICES Mental Health Outpatient Services delivers quality assurance and quality improvement activities in conjunction with strategic management. In addition, this program provides direct clinical services through partnerships with county departments, such as Probation and Social Services. Staffing Change from 2014-15 2015-16 FY15-16 Ado 2016-17 2017-18 Staffing Detail By Budget Actual Adopted to FY16-17 Rec Recommended Proposed PSYCHIATRIST 0.46 0.46 0.01 0.47 0.47 DIVISION CHIEF 1.00 1.00-1.00 1.00 PROGRAM MANAGER 1.08 2.00 (1.00) 1.00 1.00 IT MANAGER 0.22 - - - - EDP SYS & PROG ANLST SR - - 0.50 0.50 0.50 EPIDEMIOLOGIST SR 0.11 1.00-1.00 1.00 TEAM/PROJECT LDR-GEN 0.01 - - - - CLIN PSYCHOLOGIST 0.97 1.00-1.00 1.00 PSYCHIATRIC NURSE SR 1.62 2.00-2.00 2.00 QUALITY ASSURANCE COORD 1.15 3.00 1.00 4.00 4.00 ADMN OFFICE PRO 0.56 1.00-1.00 1.00 EPIDEMIOLOGIST/BIOSTAT - 1.00-1.00 1.00 DEPT BUS SPEC 2.31 1.00-1.00 1.00 ADMHS TEAM SUPV-PRACTITIONER 1.00 1.00-1.00 1.00 HEALTH CARE PROGRAM COORDINATOR 1.27 2.00-2.00 2.00 ADMHS PRACTITIONER 2.77 6.00 (4.00) 2.00 2.00 SAFETY OFFICER-DEPT 0.21 1.00 (1.00) - - SAFETY/PRIVACY OFFICER-DEPT - - 1.00 1.00 1.00 ADMHS PRACTITIONER INTERN 1.99 1.00 3.00 4.00 4.00 ADMHS PSYCHIATRIC TECH 1.09 1.65-1.65 1.65 CONTRACTOR 0.47 0.81 (0.31) 0.50 0.50 EXTRA HELP 4.12 3.65 (1.00) 2.65 2.65 Total 22.41 30.57 (1.80) 28.77 28.77 Health & Human Services D-205

MENTAL HEALTH OUTPATIENT SERVICES (CONT D) Revenue & Expenditures Change from 2014-15 2015-16 FY15-16 Ado 2016-17 2017-18 Budget By Categories of Expenditures Actual Adopted to FY16-17 Rec Recommended Proposed Salaries and Employee Benefits $ 2,770,044 $ 3,723,149 $ 20,520 $ 3,743,669 $ 3,923,613 Services and Supplies 1,059,295 2,120,617 (268,192) 1,852,425 1,895,867 Other Charges 137,060 159,897 4,950 164,847 167,177 Total Operating Expenditures 3,966,399 6,003,663 (242,722) 5,760,941 5,986,657 Other Financing Uses - 99,102 (84,851) 14,251 14,222 Total Expenditures $ 3,966,399 $ 6,102,765 $ (327,573) $ 5,775,192 $ 6,000,879 Budget By Categories of Revenues Use of Money and Property 58,132 50,000 9,168 59,168 59,168 Intergovernmental Revenue 30,973 721,693 (721,693) - - Charges for Services 3,469,562 2,463,904 (236,685) 2,227,219 2,236,367 Miscellaneous Revenue 9,212 - - - - Total Operating Revenues 3,567,878 3,235,597 (949,210) 2,286,387 2,295,535 Other Financing Sources 122,463 1,486,647 (121,000) 1,365,647 1,365,647 General Fund Contribution - 1,020,000-1,020,000 1,020,000 Total Revenues $ 3,690,341 $ 5,742,244 $ (1,070,210) $ 4,672,034 $ 4,681,182 2015-16 Anticipated Accomplishments Development of the Katie A. program to ensure screening and individualized treatment for foster care children. Creation of specialty treatment teams in all outpatient clinics to provide levels of care based on individualized needs within a full array of recovery-based treatment services. Expansion of Crisis Services & Facilities, and Forensic Team. Progression of the Forensic ming and Homeless Services Countywide to improve continuity of care, divert individuals from jail, and reduce acute hospitalizations. 2016-18 Objectives Establish evidence-based practices, delivered through specialty teams at all adult and children s outpatient clinics, to individualize services based on unique needs. Equip all outpatient adult clinics with fully developed co-occurring services to serve individuals with serious mental health, substance use, and medical conditions through a comprehensive system of recovery and resiliency. Expand community care resources by increasing the number of homeless shelter and board and care bed resources. Enhance communication and collaboration with Community Based Organizations (CBO) providers to review and update all outpatient service contracts to define and improve clinical client outcomes. Health & Human Services D-206

MENTAL HEALTH COMMUNITY SERVICES PROGRAMS Mental Health Community Services programs are services provided within Behavioral Wellness clinics and throughout community including partnerships with organizational providers. Staffing Change from 2014-15 2015-16 FY15-16 Ado 2016-17 2017-18 Staffing Detail By Budget Actual Adopted to FY16-17 Rec Recommended Proposed PSYCHIATRIST 9.07 16.52 0.34 16.85 16.85 MEDICAL DIRECTOR 0.09 - - - - STAFF PHYSICIAN - 0.25-0.25 0.25 ASST DIRECTOR 0.56 0.65-0.65 0.65 DIVISION CHIEF 1.04 2.00-2.00 2.00 PROGRAM MANAGER 1.12 3.00-3.00 3.00 REGIONAL CLINIC MANAGER 3.00 3.00-3.00 3.00 ADMHS TEAM SUPV-CLIN PSYCH 1.50 2.00 (1.00) 1.00 1.00 OPERATIONS MANAGER - - 1.00 1.00 1.00 TEAM/PROJECT LDR-GEN 0.07 - - - - CLIN PSYCHOLOGIST 2.84 3.75 (2.00) 1.75 1.75 PSYCHIATRIC NURSE SR 1.99 2.00-2.00 2.00 ADMHS TEAM SUPV-RN - 1.00-1.00 1.00 ADMN OFFICE PRO 10.00 11.00 0.50 11.50 11.50 PSYCHIATRIC NURSE 10.65 21.50 (0.60) 20.90 20.90 DEPT BUS SPEC 1.09 2.50 (1.50) 1.00 1.00 ADMHS TEAM SUPV-PRACTITIONER 10.58 12.00 1.00 13.00 13.00 HEALTH CARE PROGRAM COORDINATOR - 1.00-1.00 1.00 ADMHS PRACTITIONER 29.38 41.50 (14.00) 27.50 27.50 CLIN PSY POST DOC INTERN 1.92 2.00 2.00 4.00 4.00 ADMN OFFICE PRO SR 0.85 1.00-1.00 1.00 ADMHS REHABILITATION SPEC 3.54 5.00-5.00 5.00 ADMHS PRACTITIONER INTERN 19.38 23.00 13.00 36.00 36.00 ALCOHOL & DRUG SERVICE SPEC 3.42 3.00 1.00 4.00 4.00 ADMHS PSYCHIATRIC TECH 15.69 17.75 0.25 18.00 18.00 ADMHS TEAM SUPV-CASE WKR - 1.00-1.00 1.00 ADMHS CASE WORKER 20.69 28.50 1.00 29.50 29.50 ADMHS RECOVERY ASSISTANT 16.50 24.00-24.00 24.00 CONTRACTOR 2.43 3.30 (0.10) 3.20 3.20 EXTRA HELP 20.83 43.77 1.85 45.62 45.62 Total 188.21 275.99 2.74 278.73 278.73 Health & Human Services D-207

MENTAL HEALTH COMMUNITY SERVICES PROGRAMS (CONT D) Revenue & Expenditures Change from 2014-15 2015-16 FY15-16 Ado 2016-17 2017-18 Budget By Categories of Expenditures Actual Adopted to FY16-17 Rec Recommended Proposed Salaries and Employee Benefits $ 21,716,670 $ 28,315,335 $ 3,725,055 $ 32,040,390 $ 33,436,496 Services and Supplies 36,936,176 36,639,296 (313,322) 36,325,974 37,175,441 Other Charges 1,756,839 1,409,157 13,639 1,422,796 1,453,209 Total Operating Expenditures 60,409,685 66,363,788 3,425,372 69,789,160 72,065,146 Capital Assets (366) 1,138,994 (1,108,994) 30,000 30,000 Other Financing Uses 507,668 1,672,059 187,088 1,859,147 1,720,966 Intrafund Expenditure Transfers (+) 3,902,557-4,105,420 4,105,420 4,105,420 Increases to Fund Balances 1,825,109 - - - - Total Expenditures $ 66,644,654 $ 69,174,841 $ 6,608,886 $ 75,783,727 $ 77,921,532 Budget By Categories of Revenues Use of Money and Property 98,524 185,332 (16,541) 168,791 168,496 Intergovernmental Revenue 34,665,932 33,649,937 5,552,184 39,202,121 37,730,223 Charges for Services 21,612,744 27,473,670 1,841,970 29,315,640 30,112,579 Miscellaneous Revenue 175,575 250,000-250,000 250,000 Total Operating Revenues 56,552,775 61,558,939 7,377,613 68,936,552 68,261,298 Other Financing Sources 2,248,889 1,278,034 (965,000) 313,034 313,034 Intrafund Expenditure Transfers (-) 3,902,557-4,105,420 4,105,420 4,105,420 Decreases to Fund Balances 513,141 2,140,672 (1,166,542) 974,130 424,325 Total Revenues $ 63,217,362 $ 64,977,645 $ 9,351,491 $ 74,329,136 $ 73,104,077 2015-16 Anticipated Accomplishments Opened South County Crisis Residential to allow a step down from inpatient acute hospitalizations as well as an alternative to hospitalization for individuals willing to voluntarily receive this level of support. Established countywide Triage teams. Established Lompoc Mobile Crisis team. Opened 6 bed residential facility in South County. Health & Human Services D-208

MENTAL HEALTH COMMUNITY SERVICES PROGRAMS (CONT D) 2016-18 Objectives Continue the integration of the principles of MHSA into all outpatient programs and services that includes adherence to established evidence- based practices delivered through specialty teams at all adult and children s outpatient clinics. Implement a crisis stabilization unit in the North County. Reduce length of stay within psychiatric health facility through development of appropriate community supports and housing. Utilize MHSA housing funds to create permanent housing units. Develop strategies to expand safe and stable housing options within Santa Barbara County for complex clients. Coordination with community partners to address needs of high utilizers. Health & Human Services D-209

ALCOHOL & DRUG PROGRAMS The Alcohol and Drug programs deliver publicly funded alcohol and drug prevention, early intervention, treatment, and recovery support services provided primary by community based organizations (CBOs). Staffing Change from 2014-15 2015-16 FY15-16 Ado 2016-17 2017-18 Staffing Detail By Budget Actual Adopted to FY16-17 Rec Recommended Proposed PROJECT MANAGER 1.00 1.00-1.00 1.00 CLIN PSYCHOLOGIST 0.12 0.25-0.25 0.25 COST ANALYST 0.26 - - - - QUALITY ASSURANCE COORD - 2.00-2.00 2.00 ADMN OFFICE PRO 0.78 - - - - ACCOUNTANT 0.01 - - - - ADMHS TEAM SUPV-PRACTITIONER 2.00 2.00-2.00 2.00 HEALTH CARE PROGRAM COORDINATOR 2.81 3.00-3.00 3.00 ADMHS PRACTITIONER 0.56 2.00 (1.00) 1.00 1.00 ADMN OFFICE PRO SR 0.01 - - - - ADMHS PRACTITIONER INTERN 0.54 1.00 1.00 2.00 2.00 ALCOHOL & DRUG SERVICE SPEC 1.50 1.00-1.00 1.00 ADMHS CASE WORKER 0.01 - - - - EXTRA HELP 0.09 - - - - CONTRACTOR 0.07 - - - - Total 9.74 12.25-12.25 12.25 Health & Human Services D-210

ALCOHOL & DRUG PROGRAMS (CONT D) Revenue & Expenditures Change from 2014-15 2015-16 FY15-16 Ado 2016-17 2017-18 Budget By Categories of Expenditures Actual Adopted to FY16-17 Rec Recommended Proposed Salaries and Employee Benefits $ 1,091,352 $ 1,571,947 $ 56,473 $ 1,628,420 $ 1,698,939 Services and Supplies 10,438,144 10,462,313 734,805 11,197,118 13,617,302 Other Charges 256,968 213,935 (145,082) 68,853 70,322 Total Operating Expenditures 11,786,464 12,248,195 646,196 12,894,391 15,386,563 Other Financing Uses 208,133 135,000-135,000 135,000 Intrafund Expenditure Transfers (+) 454,549 329,853 71,908 401,761 407,787 Increases to Fund Balances 95,216 88,648 13,766 102,414 103,950 Total Expenditures $ 12,544,362 $ 12,801,696 $ 731,870 $ 13,533,566 $ 16,033,300 Budget By Categories of Revenues Fines, Forfeitures, and Penalties 3,439 2,679 821 3,500 3,500 Use of Money and Property 3,044 2,613 (2,058) 555 500 Intergovernmental Revenue 6,747,156 6,577,785 (306,716) 6,271,069 6,220,063 Charges for Services 4,574,028 4,839,342 1,060,763 5,900,105 8,079,500 Miscellaneous Revenue 100,251 92,549 9,865 102,414 103,950 Total Operating Revenues 11,427,918 11,514,968 762,675 12,277,643 14,407,513 Intrafund Expenditure Transfers (-) 454,549 329,853 71,908 401,761 407,787 Decreases to Fund Balances 613,895 912,842 (106,680) 806,162 1,170,000 General Fund Contribution 48,000 48,000-48,000 48,000 Total Revenues $ 12,544,362 $ 12,805,663 $ 727,903 $ 13,533,566 $ 16,033,300 2015-16 Anticipated Accomplishments Integrated co-occurring capacity at outpatient Mental Health clinics with use of Screenings, Brief Intervention, and Referral to Treatment for alcohol and drug issues (SBIRT). Developed capacity to care for medically compromised individuals by establishing Medicated Assisted Treatment (MAT) teams at two outpatient clinics. Sustained and expanded treatment services for drug court in the South County and for adolescents throughout the county. Expanded the Narcotic Treatment s (NTP) - now serving over 700 opioid dependent clients countywide. Enriched the Behavioral Wellness training program and issuance of hundreds of naloxone (opioid antidote) kits throughout the county to reverse ODs. 2016-18 Objectives Further integrate substance abuse services with the outpatient MHSA-funded programs. Implement State approved and expanded Drug Medi-Cal services. Health & Human Services D-211

ALCOHOL & DRUG PROGRAMS (CONT D) 2016-18 Objectives (cont d) Increase the opportunity for female specific programming and interventions for youth in the Santa Maria Juvenile Hall and at the Alternative Report and Resource Centers (ARRCs). Develop and initiate the Santa Barbara County Outpatient Delivery System for Alcohol and Drug s. Develop substance abuse treatment programming within the Juvenile Hall including SBIRT and linkage to community treatment upon release. Develop substance abuse treatment programming at the Los Prietos Boys Academy through the Strengthening Families. Coordinate and facilitate the Pew-MacArthur Results First Initiative which is designed to help assess the costs and benefits of intervention options available to the criminal justice system and allow for the use of data to make decisions based on proven results. Health & Human Services D-212